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Transcript
SENSORY CONNECTION PROGRAM: ACTIVITIES FOR MENTAL HEALTH TREATMENT Overview The Sensory Connection Program is an occupational therapy based program designed to help patients with mental health problems. When a person’s world implodes and mental illness takes over, it is a time of confusion, despair, uncontrollable feelings, loneliness, and agonizing discomfort. Treatment traditionally involves medications, counseling, talk therapy, and possibly behavioral therapy. While these treatment approaches are vital and will eventually be helpful, they take time to work and to people in mental health crisis they can seem frustratingly ineffectual in dealing with the immediate feelings of catastrophic distress. The Sensory Connection Program: • offers strategies that can be used immediately to help people calm down and regain selfcontrol. • helps patients in ways that differ from that provided by other mental health professionals. • gives patients and care providers alternative options to deal with symptoms. • provides strategies for sensory distortions, dissociation, sensory defensiveness, selfharming behaviors, negative thinking, cognitive disruptions, substance abuse, and stress management. Applicable Treatment Settings • Acute and long term mental health units • Outpatient mental health treatment programs • Substance abuse programs • Programs for patients with head injuries or neurological problems • Adolescent units • Geriatric settings • Programs for adults with Developmental Disabilities Training Packet The Sensory Connection Program Manual and Handbook provide information for training program that can be used to educate staff, caregivers, and patients. Training begins with information on the sensory systems and how each of the senses can be used for calming and alerting. Once this is understood, education is provided on the connection between sensory input and emotional regulation and stress management, along with ways the program addresses common mental health problems such as disorganization, dissociation, negative thinking, and self-injurious behaviors. Safety education is discussed as staff members and care providers need to have an appreciation of all the safety issues involved in leading groups, conducting individual treatment programs, and making changes to a patient’s environment. Sensory input can be powerful; when it is used with care, reactions are usually positive, but negative reactions can occur and staff members need to be ready to intervene. 1 Sensory Connection Program Treatment Components The Sensory Connection Program is comprised of two levels of treatment, Level I: Senseability Treatment and Level II: Coping Through the Senses Treatment as well as an Environmental Support component. Levels are determined by a number of factors including the patient’s cognitive ability. Within each level, there are activities that are used in group and individual treatment. Level I: Sense-ability Group and Individual Treatment Overview The Sense-ability Group is highly structured and features sensory and movement experiences designed to facilitate physical, emotional, and cognitive capacities so that patients who require support can relax, enjoy success, socialize with peers, and learn new heath maintenance skills in the process. The group lasts one hour; it is led by two trained leaders and can accommodate up to 12-14 patients. It is most effective when offered on a daily basis for inpatient as well as outpatient programs. The Sense-ability Individual Treatment is one-to one treatment directed towards patients who are too ill to be able to attend groups; they may be manic, in poor behavioral control, isolative, disorganized, or be resistant to treatment. Sensory activities are used to facilitate self-regulation, mental stability, and socialization. Treatment is organized through the structure of the Senseability Group stages that are used in brief condensed versions. Treatment is provided in the patient’s room by occupational therapists working on an as needed basis. Patients who will benefit the most from activities at Level I usually score between 3.2 and 4.8 on the ACLS. Other characteristics that are indicative of assignment to Level I: Sense-ability Treatment are confusion, disorganization, psychosis, impaired social skills, poor behavioral control, symptoms of mania, anhedonia, and psychomotor retardation (delayed motor responses sometimes seen in severe depression). Patients at Level I may need the assistance of family and caregivers in order to implement suggestions for environmental interventions. Patients who typically benefit include those with chronic mental illness, severe mood disorders, behavioral disorders, dementia, organic brain disorders, Schizophrenia, Schizoaffective Disorder, and developmental disorders. Level I Sense-ability: Description and Group Stages On the acute psychiatric unit where I worked at UMASS Memorial Medical Center the Senseability Group continues to be one of the most well attended groups on the unit. It provides a gateway for group participation by clients who are critically ill because it is so supportive and because it provides opportunities for success and fun. The group is carefully orchestrated to hold attention and maximize function. It is easy to run and occupational therapy students welcome the opportunity to assume leadership of this popular and enjoyable group. This group passes what I call the “Smile and Return Test.” Patients leave the group smiling and happily return because it is a welcome relief to experience “feel good” activities and to be able to socialize comfortably with peers and learn skills along the way to help get better and stay better. Many activities for each Stage are provided in this Manual and in the Handbook of the Sensory Connection Program books. Activities and equipment are chosen according to the treatment goals and strengths of the patients. Interchanging the activities from session to session allows the group to continue to be exciting and interesting for leaders and patients. 2 The stages are as follows: Welcome Stage 1, the Attending Stage, captures the patient’s attention by presenting unique sensory items. Example: A kaleidoscope Stage 2, the Moving and Breathing Stage: consists of movement routines and breathing exercises to promote relaxation and to prepare for the upcoming stages. Example: Movements set to a CD of classical music Stage 3, the Conversing Stage, allows opportunities to actively participate in the group process by answering simple questions and expressing opinions. Example: “Did this routine help you feel more relaxed?” Stage 4, the Sensing Stage, provides strong sensory input from the internal senses (vestibular, proprioception, deep pressure touch) to help improve their body awareness, feeling of self-control, and organization. Example: Beanbag Tapping Stage 5, the Acting and Interacting Stage, includes a series of target games to promote physical activity and social interactions. Example: Two target games, one being more challenging, such as a ring toss and a basketball game Stage 6, the Learning Stage, teaches skills for health management such as coping with stress, assertiveness, and use of supports; games and props are used to support learning. Example: Emotions games Group Closing 3 Level II: Coping Through the Senses Treatment Overview Patients learn how to use sensory activities for selfregulation and stress management through discussion, worksheets and games. The activities require selfdirected learning, abstract thinking and insight. Patients appropriate for this level should score between 5.0 and 5.8 on the ACLS. Patients are expected to be independent enough to make plans for stress management and their own environmental adaptations. Most patients who can benefit from Level II activities will be living independently and work when they are well. Level II treatment activities are helpful for patients with anxiety, panic attacks, mood disorders, eating disorders, Post Traumatic Stress Disorder, Dissociative Disorders, Borderline Personality Disorder, Obsessive Compulsive Disorder, Adjustment Disorder, or substance abuse problems. “Coping Through the Senses is one of the most well attended groups on our acute psychiatric care unit. Clients get involved in identifying what sensory techniques help the most. They know what calms them down, we just help them to understand the why. People leave the group empowered with ideas and resources to assist in their battle with anxiety and depression and other serious mental illnesses.” Maureen Quinlivan UMASS Medical Center Level II, Coping Through the Senses Group: Description and Treatment Topics These group activities help patients learn strategies to help deal with stress and to prevent stress and to make healthy lifestyle changes in order to prevent exacerbations of their illness. Topic 1: A Lesson on Coping Through the Senses Topic 2: Coping Through the Senses Game Topic 3: Tuning in to the Mind, Body and Emotions Topic 4: Calming and Alerting Game Topic 5: Helping Others to Cope Topic 6: Developing a Stress Management Plan Topic 7: Learning Grounding Techniques Topic 8: Developing a Sensory Input Plan Topic 9: Learning to Balance Work, Rest and Play Topic 10: Healthy Ways to Feel Good 4 Level II, Coping Through the Senses Individual Treatment: Description and Activities Therapists can use these activities, menus, and handouts to help structure individual treatment sessions that focus on emotional regulation, stress management, healthy lifestyle choices, and strategies to deal with sensory sensitivities and defensiveness. Activity 1: Beanbag Tapping Activity 2: Words for Body States and Emotions Activity 3: Self Care and Sensory Stimulation Activity 4: How to Cope and Be Calm Activity 5: How to Keep Alert Activity 6: How to Develop Grounding Techniques Activity 7: How to Identify Aversive Sensory Stimulation Activity 8: How to Develop a Stress Management Plan Activity 9: How to Balance Work, Rest, and Play Activity 10: How to Develop Healthy Sleep Habits Activity 11: How to Deep Breath and Meditate Activity 12: How to Recognize and Minimize Symptoms of Sensory Defensiveness Environmental Support Overview and Treatment Interventions The Sensory Connection Program provides environmental interventions that can be used to help patients regardless of their cognitive level. Facilities and care providers become involved by setting up equipment and space that can be used to help support patients. Teaching staff and caregivers is crucial. Recommendations are provided to help patients in crisis, for setting up a dedicated sensory room, and for making the general hospital environment more comforting. Hospital units that have initiated sensory related environmental interventions have been more effective in helping patients in poor behavioral control and the need for physical restraints has dropped significantly. The program also offers suggestions to home care providers to set up Safe Space (a designated space to be used to help patients calm down and relax) and to provide support to patients with sensory issues, anxiety, and cognitive difficulties. Intervention 1: Creating a Sensory Box Intervention 2: Strategies to Avoid the Use of Restraints Intervention 3: Acute Interventions for Self-Injurious Behaviors Intervention 4: Developing a Sensory Room Intervention 5: Suggestions for Day Room Space Intervention 6: Recommendations for Hospital Environments Intervention 7: Safe Space Intervention 8: Suggestions to Enrich Home Environments Intervention 9: Helping Patients with Cognitive Deficits Copyright © 2006 Karen M. Moore www.sensoryconnectionprogram.com 5